Back to Top Skip to main content

Understanding your TRICARE explanation of benefits

Take Command of Your Health Take Command of Your Health

Recommended Content:

TRICARE Health Program

If you’ve ever visited the doctor or hospital and used your health benefits, you’ve probably received an explanation of benefits (EOB). An EOB is sent after the claim for your visit is processed. It’s an itemized statement that breaks down the cost-shares and deductibles. While an EOB isn’t a bill, it’s still an important document to read through and understand.

Medical

Your EOB will include the date you received the medical treatment or service, along with several amounts. This includes the amount billed, the amount covered, and the amount paid by TRICARE, Medicare, or other health insurance. It will show any balance you owe your provider. It will also let you know how much has been credited toward your annual deductible and catastrophic cap.

Each time you receive an EOB, compare it to the receipt or statement from the health care provider. Contact your primary insurance claims processor if you see charges for services you didn’t get. And keep your EOB statements with your health insurance records for reference. After reviewing your EOB, you can:

  • Appeal certain decisions about your claims.
  • File an appeal within 90 days of the date of the EOB notice.

TRICARE regional and overseas contractors don’t mail EOBs to you. EOB statements are available online on your TRICARE regional or overseas contractor website. You must first log in or register on their secure portal to get access to your EOB statements online. After you log in, you can then view and print your TRICARE EOB. This gives you access to your information anytime. To get to your regional or overseas contractor website, select a link below:

TRICARE contractors don’t issue an EOB to you when claims involve services related to certain sensitive diagnoses. To learn more about this, contact your TRICARE regional or overseas contractor.

Pharmacy

Your pharmacy EOB statement is a summary of your prescription claims history when you use your TRICARE pharmacy benefit. Express Scripts, the TRICARE Pharmacy Program contractor, will send you an EOB only if there’s claim activity from a retail pharmacy or TRICARE Pharmacy Home Delivery. If you only fill your prescription at a military pharmacy, you won’t receive an EOB.

Pharmacy EOB statements are printed and mailed quarterly. However, if you sign up to receive your EOB online, you’ll get a monthly notification when it’s ready. You’ll also be able to view your statements online anytime. To register online, follow the instructions on the Express Scripts website.

Dental

If you’re enrolled in the TRICARE Dental Program (TDP), you’ll receive a Dental Explanation of Benefits (DEOB) from United Concordia Companies, Inc. that explains what was covered for your dental services. The DEOB breaks down the costs for the procedures, and helps you understand how much you have to pay in cost-shares, if any. You can view your DEOB on the TDP website. Find more about a DEOB in the TRICARE Dental Program Handbook.

Remember, an EOB and a DEOB are not bills. These statements simply show you what action TRICARE has taken on your claims. For more information related to an explanation of benefits, visit the Filing Claims section. To learn more about your health care costs, visit Costs on the TRICARE website.

You also may be interested in...

Enrollment of Active Duty Service Members in Terminal Leave Status

Policy

This memorandum describes the enrollment policy for Active Duty Service members (ADSMs) in terminal leave status. It restates our policy and provides further guidance on how ADSMs can access health care services while on terminal leave.

Policy Memorandum to Establish 2012 Monthly Premium Rates for TRICARE Reserve Select and TRICARE Retired Reserve

Policy

Clear and Legible Report Process 02-2011

Policy

The purpose of this Policy Memorandum is to document unifonn business rules for managing the Clear and Legible Report (CLR) process and incorporate these business rules as standard operating procedures at all Referral Management Centers (RMC).

TRICARE 101

Presentation
9/4/2008

TRICARE 101 presented to the Defense Health Board Sept. 4, 2008

Recommended Content:

TRICARE Health Program

Debt Collection Assistance Officer Program to Assist Service Members with TRICARE Claims Collection Problems Memorandum

Policy
<< < ... 16 17 > >> 
Showing results 241 - 245 Page 17 of 17

DHA Address: 7700 Arlington Boulevard | Suite 5101 | Falls Church, VA | 22042-5101

Some documents are presented in Portable Document Format (PDF). A PDF reader is required for viewing | Download a PDF Reader or learn more about PDFs.